Edel Doherty

Chronic disease burden associated with overweight and obesity in Ireland: the effects of a small BMI reduction at population level

BackgroundOverweight and obesity prevalence has risen dramatically in recent decades. While it is known that overweight and obesity is associated with a wide range of chronic diseases, the cumulative burden of chronic disease in the population associated with overweight and obesity is not well quantified. The aims of this paper were to examine the associations between BMI and chronic disease prevalence; to calculate Population Attributable Fractions (PAFs) associated with overweight and obesity; and to estimate the impact of a one unit reduction in BMI on the population prevalence of chronic disease.MethodsA cross-sectional analysis of 10,364 adults aged ≥18 years from the Republic of Ireland National Survey of Lifestyle, Attitudes and Nutrition (SLÁN 2007) was performed. Using binary regression, we examined the relationship between BMI and the selected chronic diseases. In further analyses, we calculated PAFs of selected chronic diseases attributable to overweight and obesity and we assessed the impact of a one unit reduction in BMI on the overall burden of chronic disease.ResultsOverweight and obesity prevalence was higher in men (43.0% and 16.1%) compared to women (29.2% and 13.4%), respectively. The most prevalent chronic conditions were lower back pain, hypertension, and raised cholesterol. Prevalence of chronic disease generally increased with increasing BMI. Compared to normal weight persons, the strongest associations were found in obese women for diabetes (RR 3.9, 95% CI 2.5-6.3), followed by hypertension (RR 2.9, 95% CI 2.3-3.6); and in obese men for hypertension (RR 2.1, 95% CI 1.6-2.7), followed by osteoarthritis (RR 2.0, 95% CI 1.2-3.2). Calculated PAFs indicated that a large proportion of chronic disease is attributable to increased BMI, most noticeably for diabetes in women (42%) and for hypertension in men (30%). Overall, a one unit decrease in BMI results in 26 and 28 fewer cases of chronic disease per 1,000 men and women, respectively.ConclusionsOverweight and obesity are major contributors to the burden of chronic disease in the population. The achievement of a relatively modest reduction in average BMI in the population has the potential to make a significant impact on the burden of chronic disease.

Site choices in recreational demand: a matter of utility maximization or regret minimization?

This paper compares the Random Regret Minimization and the Random Utility Maximization models for determining recreational choice. The Random Regret approach is based on the idea that, when choosing, individuals aim to minimize their regret – regret being defined as what one experiences when a non-chosen alternative in a choice set performs better than a chosen one in relation to one or more attributes. The Random Regret paradigm, recently developed in transport economics, presents a tractable, regret-based alternative to the dominant choice paradigm based on Random Utility. Using data from a travel cost study exploring factors that influence kayakers’ site-choice decisions in the Republic of Ireland, we estimate both the traditional Random Utility multinomial logit model (RU-MNL) and the Random Regret multinomial logit model (RR-MNL) to gain more insights into site choice decisions. We further explore whether choices are driven by a utility maximization or a regret minimization paradigm by running a binary logit model to examine the likelihood of the two decision choice paradigms using site visits and respondents characteristics as explanatory variables. In addition to being one of the first studies to apply the RR-MNL to an environmental good, this paper also represents the first application of the RR-MNL to compute the Logsum to test and strengthen conclusions on welfare impacts of potential alternative policy scenarios.

Overweight and obesity on the island of Ireland: an estimation of costs

Objectives The increasing prevalence of overweight and obesity worldwide continues to compromise population health and creates a wider societal cost in terms of productivity loss and premature mortality. Despite extensive international literature on the cost of overweight and obesity, findings are inconsistent between Europe and the USA, and particularly within Europe. Studies vary on issues of focus, specific costs and methods. This study aims to estimate the healthcare and productivity costs of overweight and obesity for the island of Ireland in 2009, using both top-down and bottom-up approaches. Methods Costs were estimated across four categories: healthcare utilisation, drug costs, work absenteeism and premature mortality. Healthcare costs were estimated using Population Attributable Fractions (PAFs). PAFs were applied to national cost data for hospital care and drug prescribing. PAFs were also applied to social welfare and national mortality data to estimate productivity costs due to absenteeism and premature mortality. Results The healthcare costs of overweight and obesity in 2009 were estimated at €437 million for the Republic of Ireland (ROI) and €127.41 million for NI. Productivity loss due to overweight and obesity was up to €865 million for ROI and €362 million for NI. The main drivers of healthcare costs are cardiovascular disease, type II diabetes, colon cancer, stroke and gallbladder disease. In terms of absenteeism, low back pain is the main driver in both jurisdictions, and for productivity loss due to premature mortality the primary driver of cost is coronary heart disease. Conclusions The costs are substantial, and urgent public health action is required in Ireland to address the problem of increasing prevalence of overweight and obesity, which if left unchecked will lead to unsustainable cost escalation within the health service and unacceptable societal costs.

Demand for safety and regional certification of food: Results from Great Britain and the Republic of Ireland

Purpose – This paper aims to explore the relationship between consumer demand for enhanced food safety features and regional identification of food amongst consumers across Great Britain and the Republic of Ireland. Design/methodology/approach – The paper uses the choice experiment method to determine preferences for food testing standards, traceability standards, health and welfare standards, region of origin and price. Findings – The results show that substantial differences exist in preferences for the features between consumers in both countries. In addition, while stark differences are apparent between the two countries, in their preferences for food originating from their local region, the results suggest that consumers perceive significant substitutability between the enhanced safety features and the local regional label in both countries. Originality/value – This paper provides a unique insight into preferences for a wide range of enhanced food safety features amongst consumers in these two countr...

Examining labelling effects within discrete choice experiments: An application to recreational site choice

Data from a discrete choice experiment aimed at eliciting the demand for recreational walking trails on farmland in Ireland is used to explore whether some respondents reach their choices solely on the basis of the alternatives label. To investigate this, this paper exploits a discrete mixtures approach that also encompasses continuous distributions to reflect the heterogeneity in preferences for the attributes and alternatives. We find evidence that a proportion of respondents choose on the basis of the label only and that differences emerge between rural and urban respondents. We provide a number of alternative explanations for why this may occur. Results highlight a large impact on welfare measures when we accommodate the fact that a proportion of respondents choose on the basis of the label only.

Models of Site‐choice for Walks in Rural Ireland: Exploring Cost Heterogeneity

Farmland can confer significant public good benefits to society aside from its role in agricultural production. In this article, we investigate preferences of rural residents for the use of farmland as a recreational resource. In particular, we use a choice experiment to determine preferences for the development of farmland walking trails. Our modelling approach uses a series of mixed logit models to assess the impact of alternative distributional assumptions for the cost coefficient on the welfare estimates associated with the provision of the trails. Our results reveal that using a mixture of discrete and continuous distributions to represent cost heterogeneity leads to a better model fit and lower welfare estimates. Our results further reveal that Irish rural residents show positive preferences for the development of farmland walking trails in the Irish countryside.

Since The Start Of The Vaccines For Children Program, Uptake Has Increased, And Most Disparities Have Decreased.

The Vaccines for Children program is a US government intervention aimed at increasing vaccination uptake by removing financial barriers that may prevent US children from accessing vaccinations. This study examined the impact that this intervention had on race and ethnicity-related and income-related disparities for diphtheria-tetanus-acellular pertussis, measles-mumps-rubella, and polio vaccinations, using data from the National Immunization Survey, 1995-2013. Vaccination rates increased across all races, ethnicities, and income groups following the introduction of the Vaccines for Children program. Disparities among race and ethnic groups narrowed considerably over time since the introduction of the vaccine program, although income-related disparities changed at different rates within racial and ethnic groups and in some cases increased. Government interventions aimed solely at reducing certain financial barriers to vaccination may fail to address other important aspects of cost or perceived benefits that influence vaccination uptake, especially among poorer children.

The impact of childhood overweight and obesity on healthcare utilisation

HighlightsA study exploring the impact of child overweight and obesity on healthcare usage.Instrumental variable corrects for endogeneity of child BMI status.IV estimates show much larger effect of BMI on GP usage and inpatient stays.Large differences in effects depending on child’s age and duration of BMI status. ABSTRACT Rising levels of childhood overweight and obesity represent a major global public health challenge. A number of studies have explored the association between childhood overweight and obesity and healthcare utilisation and costs. This paper adds to the literature by estimating the causal effect of child overweight and obesity status on use of general practitioner (GP) and hospital inpatient stays at two time points using instrumental variable (IV) methods The paper uses data from two waves of the Growing Up in Ireland survey of children when they are 9 and 13 years respectively and uses the biological mother’s body mass index (BMI) as an instrument for the child’s BMI. Our results demonstrate that child overweight and obesity status do not have a significant effect on healthcare utilisation for children when they are 9 years, but do have a large and significant effect at 13 years. Across all our models, the effects on both GP and hospital inpatient stays are found to be larger when endogeneity in childhood BMI status is addressed. Previous studies that did not address endogeneity concerns are likely to have significantly underestimated the impact of child overweight and obesity status on healthcare utilisation.

An examination of the relationships between service use and alternative measures of obesity among community-dwelling adults in Ireland

Obesity has received increased attention arising from its increasing prevalence and the implications of obesity-related problems for society and the wider economy. To estimate healthcare and non-healthcare obesity impacts, many studies rely on body mass index (BMI) as a measure of obesity. However BMI is considered to be a noisy measure of total body fat that unlike some other measures does not capture fat distribution. This study uses one such measure, the waist-to-hip ratio, as both an alternative and in conjunction with BMI in the estimation of the relationship between adiposity and health service use. The article uses data from a large-scale study of older adults living in Ireland (the Tilda data set). The findings indicate that studies that include both measures of general and central adiposity may provide a more comprehensive characterisation of the relationship between healthcare service use and adiposity.

Comparing the clinical-effectiveness and cost-effectiveness of an internet-delivered Acceptance and Commitment Therapy (ACT) intervention with a waiting list control among adults with chronic pain: study protocol for a randomised controlled trial

Introduction Internet-delivered psychological interventions among people with chronic pain have the potential to overcome environmental and economic barriers to the provision of evidence-based psychological treatment in the Irish health service context. While the use of internet-delivered cognitive–behavioural therapy programmes has been consistently shown to have small-to-moderate effects in the management of chronic pain, there is a paucity in the research regarding the effectiveness of an internet-delivered Acceptance and Commitment Therapy (ACT) programme among people with chronic pain. The current study will compare the clinical-effectiveness and cost-effectiveness of an online ACT intervention with a waitlist control condition in terms of the management of pain-related functional interference among people with chronic pain. Methods and analysis Participants with non-malignant pain that persists for at least 3 months will be randomised to one of two study conditions. The experimental group will undergo an eight-session internet-delivered ACT programme over an 8-week period. The control group will be a waiting list group and will be offered the ACT intervention after the 3-month follow-up period. Participants will be assessed preintervention, postintervention and at a 3-month follow-up. The primary outcome will be pain-related functional interference. Secondary outcomes will include: pain intensity, depression, global impression of change, acceptance of chronic pain and quality of life. A qualitative evaluation of the perspectives of the participants regarding the ACT intervention will be completed after the trial. Ethics and dissemination The study will be performed in agreement with the Declaration of Helsinki and is approved by the National University of Ireland Galway Research Ethics Committee (12/05/05). The results of the trial will be published according to the CONSORT statement and will be presented at conferences and reported in peer-reviewed journals. Trial registration number ISRCTN18166896.